老年急性胆囊炎腹腔镜胆囊切除术

目的总结老年急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）经验。方法回顾性分析279例LC临床资料，其中急性结石性胆囊炎263例，单纯胆囊腺瘤8例，单纯胆囊息肉样病变5例，无明显原因3例。结果LC手术成功率87．5％（244／279），中转开腹手术35例，无严重并发症，无手术死亡。结论老年人常合并其他脏器疾病，LC围手术期危险性增高，应严格掌握手术适应证，正确处理合并症，术中放宽中转开腹指征是预防和减少并发症的关键。     

腹腔镜胆囊切除术在急性胆囊炎中的应用

目的评价急性胆囊炎中应用腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的方法和疗效. 方法回顾分析1998年8月～2003年8月LC治疗急性胆囊炎201例. 结果本组均于入院24 h内行LC.完成LC 192例(95.52%),中转开腹9例.手术时间40～150 min,平均85 min.随访2～12个月,无并发症. 结论急性胆囊炎中应用LC难度大、变异多,但只要严格掌握手术适应证和手术技巧,在基层医院开展LC是可行的.     

Laparoscopic cholecystectomy for acute cholecystitis

From October 1991 to March 1994, 35 patients (20 men and 15 women) with acute cholecystitis (AC) underwent laparoscopic cholecystectomy (LC). They ranged in age from 17 to 82 years (mean, 51.7 years). Nine of the 35 patients (25.7%) had either percutaneous transhepatic gallbladder drainage (PTGBD) or percutaneous transhepatic gallbladder aspiration (PTGBA) performed preoperatively. The mean operative time was 183.7 min. Four of the 35 patients (11.4%) required conversion to open laparotomy. The mean postoperative hospital stay was 11.2 days and postoperative morbidity rate was 2.9%. There were no major complications and no deaths. In this retrospective study, we divided the patients into three groups according to the surgical timing of LC in relation to onset. Two of the three groups had LC performed more than 7 days after onset; these groups were termed, collectively, the delayed LC group. The group that had LC performed within 7 days of onset we termed the early LC group. The early LC group had a shorter operative time, less blood loss, and a shorter postoperative hospital stay than the delayed LC group, but the differences were not significant. Nevertheless, we suggest that early LC for AC should be employed for patients who are in a stable condition and who have no preoperative associated medical problems. In the delayed LC group, there were no significant differences in findings between patients who received or did not receive either PTGBD or PTGBA. PTGBD and PTGBA are useful procedures for the relief of acute severe symptoms in patients whose condition is refractory to treatments such as i.v. antibiotic infusion and no oral feeding. We conclude that a laparoscopic procedure for patients with AC, when performed by experienced surgeons, is safe, technically feasible, and useful.     

腹腔镜胆囊切除术治疗急性胆囊炎

目的 评价腹腔镜胆切除术（ＬＣ）治疗急性胆囊炎的手术指证,手术时机和手术经验。方法 对１９９３年４月～２０００年３月ＬＣ治疗急性胆囊炎４２例的临床资料进行回顾性分析。结果 术前发病时间〉７２小时者（９例）与〈７２小时者（３３例）的比较,后者行ＬＣ的平均手术时间及术后平均住院日均较短,中转开工发症率及平均住院费用亦较低,坏疽性胆囊炎组的中转开腹率明显高于非坏疽性胆囊炎组（Ｐ〈０．０５）,结论 急性胆     

急性胆囊炎腹腔镜切除术式选择

目的 :探讨急性胆囊炎行腹腔镜胆囊切除术的安全性。方法 :腹腔镜对急性胆囊炎的治疗分别选择 :胆囊大部分切除、胆囊前壁切除、胆囊完整切除三种术式。结果 :顺利完成腹腔镜胆囊切除 2 32例 ,中转手术 4例。全组无死亡病例 ,无胆道损伤、大出血等严重并发症。结论 :随着腹腔镜胆囊切除术经验积累和器械完善 ,急性化脓、坏死性胆囊炎甚至胆囊穿孔已不再是腹腔镜胆囊切除的禁忌证 ,均可在急性炎症期完成腹腔镜胆囊切除术。     

Laparoscopic cholecystectomy for acute cholecystitis

Summary Because laparoscopic cholecystectomy reduces hospitalization time and postoperative disability, it is being offered to an increasing number of patients with symptomatic gallstones. Nevertheless, acute cholecystitis is still considered by many surgeons to be a relative contraindication. Our standard approach has been to perform laparoscopy on all patients considered candidates for cholecystectomy. From June 1990 to October 1991, the authors personally performed laparoscopic cholecystectomy on 110 patients, 29 (26%) of whom had pathologically confirmed acute cholecystitis. Of these, nine had evidence of gangrene, perforation, or abscess formation. It was necessary to convert to open cholecystectomy in four (14%) patients. In each, inflammation or dense adhesions precluded the performance of a safe operation. The hepatorenal space was drained in 12 (41%) and cystic dust cholangiograms were performed selectively. The mean operating time was 108 min. There were no intraoperative complications. One patient developed a prolonged postoperative paralytic ileus and two patients were noted to have postoperative common duct stones. There were no deaths. The average postoperative stay for laparoscopic cholecystectomy was 2.6 days. We conclude that the advantages of laparoscopic cholecystectomy can be safely and effectively extended to the majority of patients with acute cholecystitis.     

Laparoscopic cholecystectomy for acute cholecystitis

Background  The aim of this study is to present our experience and results with performing laparoscopic cholecystectomy for acute cholecystitis evaluating the effect of timing of surgery and the influence of the various types of gallbladder inflammation on patient outcome. Materials and methods  The patients were separated in three groups according to the time between the onset of symptoms and the operation: the “early” group was defined as laparoscopic cholecystectomy completed in the first 72 h after the onset of the symptoms, the “intermediate” group from 4 to 7 days, and the “delayed” group with symptoms lasting more than 8 days. Results  Two hundred twenty-five patients underwent laparoscopic cholecystectomy. There were 115 patients who underwent “early” surgery; 70 patients underwent “intermediate” surgery, and 70 patients underwent “delay” surgery. The total number of converted cases was 32 (12.5%). There were 124 cases of acute cholecystitis, 53 cases of gangrenous cholecystitis, 27 cases of hydrops, and 51 cases of empyema. There was no significant difference in complication rate, mortality, and postoperative hospital stay. Conclusions  Laparoscopic cholecystectomy can be accomplished safely in most patients with acute cholecystitis. The timing of surgery has no clinical relevant effect on conversion rates, operative times, morbidity, and postoperative hospital stay.     

腹腔镜手术治疗急性胆囊炎的疗效研究

目的对比腹腔镜手术和开腹手术在急性胆囊炎患者中的疗效及对炎症因子、血清淀粉酶水平的影响。 方法选取2015年12月至2017年7月收治的急性胆囊炎患者86例,按照数字表法随机分为两组,开腹组和腹腔镜组,各43例。数据采用SPSS18.0进行分析,临床疗效和术后并发症采取卡方检验;血清淀粉酶及炎症因子应用( ±s)检验,独立t检验,P<0.05差异有统计学意义。 结果腹腔镜组患者的临床有效率95.3%优于开腹组81.4%(P<0.05);腹腔镜组的手术中出血量、手术时长、排气时长、下床活动时长、住院天数及术后并发症均低于开腹组(P<0.05);治疗后两组患者的血清淀粉酶及炎症因子均发生不同程度升高,但腹腔镜组各项指标水平显著低于开腹组(P<0.05)。 结论急性胆囊炎患者使用腹腔镜手术的临床疗效更显著,患者创口小,术后恢复时间更短、并发症更少,值得应用及进一步推广。     

Laparoscopic cholecystectomy for acute cholecystitis

The application of laparoscopic cholecystectomy (Lap. C) for acute cholecystitis (AC) remains controversial from the viewpoint of its higher rate of morbidity, and conversion to open surgery, in spite of the worldwide acceptance of Lap. C as the gold standard for the treatment of patients with symptomatic gallbladder diseases. The conversion rate has been reported to decrease with experience. Local and overall complication rates were shown to correlate with the time delay between the onset of acute symptoms and the operation. Although percutaneous gallbladder drainage (PGBD) has been reported to be a safe and effective procedure for the treatment of AC, it should be limited to high-risk groups such as elderly or critically ill patients. Early cholecystectomy within 4 days from the onset is strongly recommended to minimize surgical complications and to increase the chance of a successful laparoscopic approach. Received: April 29, 2002 / Accepted: May 30, 2002 Offprint requests to: S. Kitano     

老年人急性胆囊炎的腹腔镜手术治疗

目的:探讨老年人急性胆囊炎的临床特点,更好地把握腹腔镜胆囊切除(LC)术的时机和方法。方法:回顾分析32例老年人急性胆囊炎LC的临床资料,比较早期(急性发作48h内)LC及延期(急性发作48h后)LC的治疗结果。结果:早期及延期LC均获成功,患者全部治愈,未发生严重并发症;但延期LC的平均手术时间及术后平均住院日期较长。结论:老年人急性胆囊炎病情进展快,手术难度大、风险高;只要高度重视围手术期的处理,把握手术时机及技巧,早期LC是安全、可行的;除病情危重不能耐受手术者外,多数患者均应尽早施行LC。     

Laparoscopic cholecystectomy for acute cholecystitis in elderly patients.

BACKGROUND: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. METHOD: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. RESULTS: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (< or =65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P = 1). CONCLUSION: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age.     

Laparoscopic cholecystectomy in acute cholecystitis

The authors retrospective analyze the role of golden standard laparoscopic cholecystectomy for the treatment of acute cholecystitis. They make a comparison between the results of 50 early cholecystectomy and 44 "a froid" cholecystectomy (operation was postponed until 6 weeks after acute cholecystitis had healed). From January 1997 to December 1998 536 laparoscopic cholecystectomies were performed. In 491 cases (91.6%) laparoscopic, and in 45 cases (8.4%) traditional (opening) method was indicated. Converted cholecystectomies were in 36 cases (7.3%). Agreeing to the literature they can determine the optimal timing of the operation in 72 hours from the onset of acute cholecystitis [2, 4]. In this group (first group) there were 50 cases, with 14 conversions (28%). In the second group (postponed, so called "a froid" phase) there were 44 patients. From this group was the intraoperative diagnosis serious acute-subacute cholecystitis in 24 cases (54.54%) causing complicated laparoscopic cholecystectomy and resulting in 11 conversions (11/44: 25%). The causes of the higher rate of conversion were the grave inflammation and slow dissection of central formation. There were no serious complication and mortality in both groups. It was diagnosed bile leak (two cases) which ceased spontaneously, one haematoma in abdominal layers, and one trocar's hernia. The authors have recommended the laparoscopic cholecystectomy for early diagnose acute cholecystitis in order to prevent the complications and reduce the sick-leave. Supporting their viewpoint the most important clinical end economical facts are: the recurrence of inflammation forced urgent surgery and caused more complication in the course of "a froid" phase there were scrutable anatomical situation the patients recovered in a shorter time.     

Laparoscopic cholecystectomy in acute cholecystitis

Background: In the light of laparoscopic cholecystectomy increasingly applied to all forms of cholecystitis, this study aimed at evaluating the safety of laparoscopic cholecystectomy applied to all cases of acute cholecystitis, and at determining factors associated with the risk of conversion to open cholecystectomy. Methods: The clinical, biochemical, radiologic, and operative data from 124 consecutive cases of acute cholecystitis were analyzed retrospectively to determine the complications and morbidity after operation. The data were analyzed further by univariate and multivariate analysis to identify factors associated with conversion. Results: No major bile duct injury or mortality occurred. Bile leak from the stump of the cystic duct developed in four patients. These were managed successfully by endoscopic biliary stent placement. The mean duration of hospital stay was 3.8 days in the laparoscopic group and 8.2 days in the open group. Of the 124 patients (18.5%), 23 underwent conversion to open cholecystectomy. Univariate analysis identified the following factors as associated with conversion: common duct dilation greater than 7 mm observed on ultrasound, (p < 0.05), pericholecystic collection seen on ultrasound (p < 0.0001), emphysematous cholecystitis (p < 0.01), endoscopic retrograde cholangiopancreatographic evidence of Mirizzi syndrome (p < 0.05), and pericholecystic collection at operation (p < 0.0001). On multivariate analysis, only pericholecystic collection (p < 0.015) and gallbladder wall thickness greater than 5 mm (p < 0.013) were statistically significant. Conclusions: Laparoscopic cholecystectomy for acute cholecystitis can be applied safely to all comers, offering the advantage of a shortened hospital stay. Pericholecystic collection, as observed on ultrasound, is associated with a high risk of conversion to open cholecystectomy.     

Laparoscopic cholecystectomy in acute cholecystitis

BACKGROUND: The aim of this prospective study was to compare the outcome of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis versus those with chronic cholecystitis and to determine the optimal timing for LC in patients with acute cholecystitis. METHODS: From January 1991 to July 1998, 796 patients (542 women and 254 men) underwent LC. In 132 patients (67 women and 65 men), acute cholecystitis was confirmed via histopathological examination. These patients were divided into two groups. Group 1 (n = 85) had an LC prior to 3 days after the onset of the symptoms of acute cholecystitis, and group 2 (n = 47) had an LC after 3 days. RESULTS: There were no mortalities. The conversion rates were 38.6% in acute cholecystitis and 9.6% in chronic cholecystitis (p<10(-8)). Length of surgery (150.3 min vs. 107.8 min; p<10(-9)), postoperative morbidity (15% vs. 6.6%; p = 0.001), and postoperative length of stay (7.9 days vs. 5 days; p< 10(-9)) were significantly different between LC for acute cholecystitis and elective LC. For acute cholecystitis, we found a statistical difference between the successful group and the conversion group in terms of length of surgery and postoperative stay. The conversion rates in patients operated on before and after 3 days following the onset of symptoms were 27% and 59.5%, respectively (p = 0.0002). There was no statistical difference between early and delayed surgery in terms of operative time and postoperative complications. However, total hospital stay was significantly shorter for group 1. CONCLUSIONS: LC for acute cholecystitis is a safe procedure with a shorter postoperative stay, lower morbidity, and less mortality than open surgery. LC should be carried out as soon as the diagnosis of acute cholecystitis is established and preferably before 3 days following the onset of symptoms. Early laparoscopic cholecystectomy can reduce both the conversion rate and the total hospital stay as medical and economic benefits.     

腹腔镜胆囊切除术在老年人急性胆囊炎中的应用

目的:探讨老年人急性胆囊炎行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)的时机及方法。方法:回顾分析2003年5月~2005年5月23例急性胆囊炎老年患者的临床资料。结果:LC均获成功,患者全部治愈,未发生严重并发症。结论:老年人急性胆囊炎的病情进展快,手术难度大,风险高;要高度重视围手术期的处理,把握手术时机及技巧。早期LC是安全可行的。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎

目的:探讨急性结石性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的术中处理及并发症的防治。方法:回顾分析2004年11月至2009年11月为63例急性结石性胆囊炎患者行LC的临床资料。结果:53例成功行胆囊切除术,3例胆囊大部切除+胆囊粘膜电灼术,7例中转开腹,无死亡、大出血及胆管损伤。结论:急性结石性胆囊炎行LC是安全可行的,提高腹腔镜技术、适时中转开腹是防治并发症发生的关键。     

急性结石性胆囊炎行腹腔镜胆囊切除术的临床研究

目的探讨急性结石性胆囊炎发作行腹腔镜胆囊切除术(LC)的疗效及应用价值。方法回顾性分析2004年1月至2008年10月120例急性结石性胆囊炎LC手术临床资料。结果120例中除2例中转开腹外,余腹腔镜手术均获成功,手术时间60~130 min,术后2~5 d拔除腹管,无切口感染,痊愈出院,住院5~7 d,无并发症发生。结论选择合适的手术时机及方式,医师需具备熟练的腹腔镜操作技术,急性结石性胆囊炎行LC手术是安全可行的。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎临床体会

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗急性结石性胆囊炎的手术及操作要点。方法：回顾分析我院2000年3月-2009年8月行LC治疗的1260例急性胆囊炎并胆囊结石病例。结果：顺利完成LC1220例,中转开腹胆囊切除术40例,无术中大出血、肝外胆管损伤而中转开腹的病例。无术后胆汁漏、腹腔内出血等严重并发症发生。所有患者随访3月～1年,无胆管狭窄等相关并发症发生。结论：LC治疗急性胆囊炎安全可行,术者必须充分了解LC操作要点和熟练掌握操作技术。     

Laparoscopic cholecystectomy for acute cholecystitis.

Sixty-eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty-two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC. One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC. Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be performed.